Optimising the management of rotator cuff dysfunction

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Copyright: Cole, Brandi
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Abstract
Rotator cuff dysfunction is a common cause of shoulder pain. The aim of this thesis was to investigate the best way to accurately diagnose rotator cuff dysfunction and evaluate commonly used treatments and newer alternate injections for this condition. Methods: Two diagnostic accuracy studies were conducted to compare ultrasound performed by an experienced musculoskeletal sonographer to ultrasound performed by a general sonographer and MRI for the diagnosis of rotator cuff tears, using findings at arthroscopy as the gold standard. A randomised, double blinded clinical trial was conducted to compare the effectiveness of ultrasound guided subacromial corticosteroid injections to landmark guided (blind) subacromial corticosteroid injections for the treatment of rotator cuff dysfunction in 56 patients. A second randomised, double blinded clinical trial was conducted to compare subacromial corticosteroid injections to glucose prolotherapy injections into the supraspinatus tendon for supraspinatus tendinopathy in 36 patients. Results: Musculoskeletal sonography, general sonography and MRI had high sensitivities and specificities for diagnosing rotator cuff tears. All were more accurate at diagnosing full thickness tears than partial thickness tears. Musculoskeletal sonography was more sensitive and specific than general sonography and had similar sensitivity and specificity to MRI for diagnosing rotator cuff tears. Visual Analogue Scale (VAS) for pain with overhead activities decreased and functional scores on American Shoulder and Elbow Surgeons Score (ASES) increased at six weeks post subacromial corticosteroid injection in both the ultrasound guided group and the blind group with no significant difference between the groups at six weeks. Level of pain with overhead activities was significantly reduced at three months post glucose prolotherapy injection and at six months post prolotherapy and corticosteroid injection, however there were no significant differences between the groups at any time point for any outcome measure. Conclusion: Ultrasound in the hands of an experienced musculoskeletal sonographer is highly accurate for the diagnosis of rotator cuff tears. Ultrasound guidance of subacromial corticosteroid injection for the treatment of rotator cuff dysfunction provides no additional benefit to blind subacromial injection. Glucose prolotherapy offers no additional benefit over subacromial corticosteroid injection for supraspinatus tendinopathy.
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Author(s)
Cole, Brandi
Supervisor(s)
Murrell, George AC
Lam, Patrick
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Publication Year
2018
Resource Type
Thesis
Degree Type
PhD Doctorate
UNSW Faculty
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